HomeMy WebLinkAboutBUILDING PERMIT APPLICATION4
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St. Lucie County "rQ 0
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ALLAPPLICAWINIF BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1715 IT PermitNumber: i�N- M571
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential — V/-
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 3'6192 oil-A,\aice NJ)5' v-r li)v&,itco -r-t— 349�1_
Legal Description:
Property Tax ID #: V74()b -a 9�5 - OOC)3� (30-
SitePlanName:- Sey�"VL4-12- VVVt.6% �0
Project Name: 7016
Setbacks Front Back: RightSide: Left Side:
DETAILED DESCRIPTION OF WORK:
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Lot No.
Block No.
CONSTRUCTION INFORMATI
ON:.:
Additional work to be Dertormea unclerinirpemn�E-cneCK511; pprT--" 14 " . k.
s Piping Sh'utters �yi'dovis/Dciors
H VA"I GasTank E]GIa,
Electric [�Plumbing oSprinklers R-0_0-f I Roof pitch
Total Sq. Ft of Construction: �2�0 S Ft f First Floor: q e C)
Cost of Construction:$ fg-�� 1616t�o Utilities'VSevver 0 Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name _k VK0 'S% (.0
Name: , 1�roc-(E_ W-CLA064
Address: A., Pn�
W u Ii vA-,,IL#A
Company: Me—L-54 YVVC,)3'ka.
City: sill
Zip Code, 7— Fax:
Phone No.
State: L11 I
Address: 14 0 I'l-) ' I
city: L-A 4e WAV--1 State,_LL-
Zip Code: '2--7 L4 �e Fax: —
Phone No- gol piyv:;�=_00
E-Mail,
Fill In fee simple Title Holder an next page (if different
from the owner listed above)
r
E-Mail: cl- ca
State or County License: -r 44
If value of construction is $ZS00 or more, a RECORDED Notice of Commencement is required.
6 0
I SUPPLEMENTAL CONSTRUcTiON LIEN LAW INFORMATION: I I
City: ' - State:
Zip: Phone
COMPANY. _ZNot Applicable
Address:
City: State:
Zip: _ Phone:
FEE SIMPLE TITLE HOLDER: __3ZNot Applicable I BONDING COMPANY:
Address: Address:
City: City._
Zip: Phone: Zip: _ Phone:
OWNER/ CONTRACTORAFFIDVIT: Application is hereby made to obtain a permit to do the work and instaiiation as inu,4.,�--
I certify that no work or installation has commenced prior to the issuance of a permit.
St.LucieCoun makes no representation that is granting a permit will authorize the ermit holder to build the subject stmcture
which is in conwict with any applicable Home Owners Association rules, bylaws or anscovenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
in consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance With the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concumency review., room additions,
accessory structures, swimming pools, fences, mils, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in Vour paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. 1� ou intend to obtain financing, consult with lender or an attorney before
ommencmF! work or recordx �our Notice of Commencement.
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Signature of Omer/ Lessee/Contmctoras Agent for Omer
SignatUre of Contractor/License Holder
STATE OF FLORIDA
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STATE OF FLORIDA4;)- (i)(re
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COUNTY OF
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Nameofpersoni kingstatement
Name of persoyini-agnIstatefnent
Personally k .... .... C'"'OR Produced Identification
Persona�ly Known 4./ OR ProducM Identification
Type of Identification
Typ I entificat on
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ERESK BRYAN
"%ic-Stat RUAMYAN
(SigNatureo 99
(Signat P E
Commission # FF 987475
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Commission 11 MY COmmitSO411 Expires
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Commir'f.'YA n
%"'.1.-'V May 01, 2020
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Rev. 8/2/17